| 李菁,马小静,程冠.实时经食管三维超声心动图在牛心包主动脉瓣置换术中的应用[J].中国医学影像技术,2020,36(4):484~488 |
| 实时经食管三维超声心动图在牛心包主动脉瓣置换术中的应用 |
| Application of real-time 3D-transesophageal echocardiography in aorta valve replacement with bovine pericardium |
| 投稿时间：2019-03-22 修订日期：2020-04-08 |
| DOI：10.13929/j.issn.1003-3289.2020.04.002 |
| 中文关键词: 主动脉瓣 超声心动描记术,经食管 心脏外科手术 |
| 英文关键词:aortic valve echocardiography, transesophageal cardiac surgical procedures |
| 基金项目:国家重点研发计划项目（2017YFC0113003）。 |
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| 中文摘要: |
| 目的 评价术中实时经食管三维超声心动图（RT-3D-TEE）在牛心包主动脉瓣置换术中的应用价值。方法 对66例接受牛心包主动脉瓣置换术患者，分别于体外循环前采用术中实时经食管二维超声心动图（RT-2D-TEE）和RT-3D-TEE探查主动脉瓣并测量相关参数，与术中探查结果及直视测量参数进行对比，观察超声测量主动脉瓣参数与术中测量结果的相关性，评价瓣叶损坏程度。分别于术后1、6个月随访观察主动脉相关参数及瓣膜功能情况。结果 RT-2D-TEE和RT-3D-TEE首要诊断与术中探查结果符合率均为100%；5例RT-2D-TEE次要诊断与术中探查存在差异（符合率92.42%，61/66），其中2例RT-3D-TEE次要诊断亦与术中探查存在差异（符合率96.97%，64/66）。RT-2D-TEE与RT-3D-TEE对主动脉瓣瓣叶数目、瓣叶穿孔、瓣叶赘生物及风湿性主动脉瓣损害与术中探查结果高度一致，RT-3D-TEE诊断符合率更高。RT-2D-TEE所测主动脉瓣环径、主动脉窦部和主动脉窦管交界直径、有效高度（eH）测值低于与RT-3D-TEE测值和术中实测结果（P均<0.05）；RT-3D-TEE与术中实测量差异无统计学意义（P>0.05），与实测值更为接近。术后6个月90.91%（60/66）患者主动脉瓣反流低于中度。结论 3D-TEE可评价牛心包主动脉瓣置换术的可行性，其测量值与术中测值接近，对手术具有重要指导作用。 |
| 英文摘要: |
| Objective To observe the application value of real-time 3D-transesophageal echocardiography (RT-3D-TEE) in aortic valve replacement with bovine pericardium. Methods Totally 66 patients underwent aortic valve replacement with bovine pericardium were enrolled. Parameters and abnormalities of aortic valve were measured before cardiopulmonary and during intraoperation by using real-time 2D-transesophageal echocardiography (RT-2D-TEE) and RT-3D-TEE,and the examination outcomes were compared with the results of surgical operation. The correlations of transesophageal echocardiography and intraoperative measurements of aortic valve parameters were observed, and the degrees of leaflet damage were assessed. The aortic related parameters and valve function were observed using RT-3D-TEE 1 and 6 months later. Results The coincidence rate of initial diagnosis of RT-2D-TEE and RT-3D-TEE with intraoparetive diagnosis was all 100%. The secondary diagnosis of RT-2D-TEE was inconsistent with intraoparetive diagnosis in 5 cases (coincidence rate 92.42%, 61/66), also of RT-3D-TEE (coincidence rate 96.97%, 64/66) in 2 cases among them. Comparing RT-2D-TEE and RT-3D-TEE in the diagnosis of number of leaflets, leaflet perforation, leaflet vegetation and rheumatic aortic valve damage) in all 66 cases, the coincidence rate of RT-3D-TEE was higher than that of RT-2D-TEE. The diameter of aortic annular, aortic sinus and aortic sinus tube, effective height (eH) measured with RT-2D-TEE were lower than those with RT-3D-TEE and intraoperative measurement (both P<0.05). There was no significant difference between RT-3D-TEE and intraoperative measurement (P>0.05). RT-3D-TEE measured values were closer to intraoperative measurement compared with RT-2D-TEE. Six months after aortic valve replacement, less than moderate aortic regurgitation was found in 60 patients (60/66,90.91%). Conclusion RT-3D-TEE measurement can reflect the actual situation realistically and evaluate the feasibility of surgical operation, therefore being valuable for guiding aortic valve replacement with bovine pericardium. |
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